Dr. Brennan has been involved with brain tumor research and the surgical treatment of these conditions for 20 years. Brain tumors are made up of either tumors that started in the brain or those that started somewhere else in the body and metastasized to the brain. Dr. Brennan discourages the use of the terms “benign or malignant” as this over simplifies the problem. “Many so called benign brain tumors can wreck havoc on a patient and their family as they can be a lifelong struggle to fight off recurrence and further growth” states Dr. Brennan. “All tumors grow. Some slow, some very quickly but they grow” explains Dr. Brennan. The removal of a brain tumor or a surgery to reduce the size of a tumor can be a long surgery and Dr. Brennan and the team at Southwest Medical Center in Lafayette hold their mission very close to their hearts. To support the patient and the family during this trying time with education and comfort.
Once the most feared of all neurosurgical problems, the aneurysm today has found itself the focus of a revolution in treatment with the advancement of interventional radiology to treat approximately 50% of the aneurysms in the United States. This specialized field uses titanium coils that resemble microscopic steel wool to fill aneurysms through a catheter without even opening the patients head. The catheters are the same ones used for doing angiograms and this technology has saved countless lives over the years. Occasionally, a patient will be a better candidate for open surgical clipping. In a patient who has had a hemorrhage from an aneurysm, time is of the essence and one approach or the other will be considered on an urgent basis. With the advent of MRI, now more and more people are discovering aneurysms on routine MRI studies and such a patient has some time to organize and make careful, well thought through decisions regarding the treatment they wish and the risks they are comfortable with. Dr. Brennan has had extensive experience at Vanderbilt with complex as well as simple aneurysms and will always counsel the family of the patient with what he recommends from the moment an event occurs. In some situations, surgery needs to be performed as an emergency while in other cases, consultation with specialized radiologists may be appropriate.
When you hear of someone having a “brain hemorrhage”, it is important to know that there are several types and each has its own level of severity.
This term literally means “on top or outside the dura”. The dura is the smooth, parchment like covering over the brain tissue. This is the development of a collection of usually fresh bleeding just under the bony portion of the skull between the skull and the brain. The presence of the blood pushes on the brain and causes symptoms of headache, nausea, vomiting, loss of consciousness and when severe, coma. The bleeding itself is usually over with in about 5 minutes but the presence of the mass of blood may take hours for the symptoms to fully develop. There is rarely any continuation of the bleeding. Treatment involves prompt diagnosis, CT scanning and surgery to open the affected side of the head and remove the clot. Patients recover over several days in an intensive care unit and many recover normal function.
This term means “under the dura” and is usually the result of either trauma in young patients or in the elderly, a gradual shrinkage of the brain and separation from the bony skull on the inside leaving room for a torn vein or artery to fill the gap with blood.
When diagnosed, the treatment usually involves surgery to remove the blood. Sometimes, in the elderly, simple drains may be placed in the ICU to drain off the liquefied blood over a few days in the ICU.
This term means the bleeding happened in the cortex or the brain substance itself. Many conditions can cause this but stroke and hypertension are the leading causes. In many instances, patients can be monitored and surgery avoided if the hemorrhage is small. In larger hemorrhages, surgery is needed to remove the clotted blood as continued pressure by the blood clot can worsen coma and lead to irreversible damage. Recovery from a large bleed can take several weeks to months and may involve post hospital rehabilitation.
This is a relatively rare condition that can happen to individuals with either reduced immune systems from chemotherapy, HIV, AIDS or some rare immune diseases. In healthy individuals it can occur simply from bacteria entering the blood stream during a procedure such as dental work, or the treatment of an abscess somewhere else in the body. Sometimes, foreign travel can result in the ingestion of uninspected meat products and the ingestion of meat contaminated with parasitic organisms can result. The most common world-wide being a parasite called cysticercosis. The presence of the parasite in the brain is the leading cause of seizures in third world countries. The surgery to treat this condition involves opening the head and exposing the brain and dissecting down to the cyst containing the parasite and removing it like you would a brain tumor. Patients are then started on anti-parasitic medicines to combat the organism elsewhere in the body.